Monthly Archives: May 2017

Street plays on ‘adolescent reproductive & sexual health’

2017-05-31

Under the aegis of National Health Mission, along with District Health Society, Kohima, department of Health & Family Welfare conducted an Adolescent Reproductive & Sexual Health (ARSH) on May 27, at Chandmari colony ward No-12 & WN-13 and Jalukie.

Chandmari colony Kohima: The adolescent club members carried out IEC activity in the form of “street play” to educate and create awareness amongst adolescence group.

The programme was chaired by media officer Kungcham Dailiam, with words of encouragement to adolescent members before the play.

Dy MEIO took the technical part by imparting health talk on ARSH. She informed on what an adolescent health was and sensitized the participants.

Speaking on the importance of Weekly Iron Folic Acid Supplement (WIFS), she imparted on anaemia problems, dangers of early pregnancy, hygienic issues to inculcate a healthy fitness life style amongst the students. She also mentioned on the ‘adolescents’, guide on abstinence, which was a good way to protect oneself from risk pregnancy, HIV/AIDS and other Sexually Transmitted Infections (STIs).

Street play on topic “danger of early pregnancy” was acted at Chandmari ward No-13 street in collaboration with IEC Bureau activities on NCD. Adolescents also acted on the topic “Menstrual Hygiene” at Ward No-12 during a medical camp from Urban Primary Health Centre.

Jalukie: Likewise the District Health Society, Chief Medical Office Peren along with the Adolescent Club and District IEC Personnels conducted street plays on “teenage pregnancy and early marriage” on May 27 at Jalukie.

State team from the directorate of Health & Family Welfare, IEC Bureau led by health education and training officer, Supongla and her team and program coordinator NCD, Abeni attended the plays for monitoring and supervision.

The Street play aims on educating and creating awareness on the issues, its causes and risk factors and its consequences.

The plays were conducted in Christian High School, Jalukie Town, Baptist High School Samzuiram Village and in main town.

Health talks were also given by IEC personnel to create more intensive awareness.

Questionnaire on teenage pregnancy was also distributed to assess the impact of the plays and whether awareness was effective.

What Led To My Fight For Sexual Health Rights Of Unmarried Indian Women

I sit in the foyer of a co-working space – which is occupied mostly by male workers, this Sunday – and stare at the diagram of a vulva. “That’s the clitoris,” I point with conviction. “No! The clitoris is at the top, you idiot!” my neighbour, a 20-year-old Delhi University (DU) student, whispers at me.

There are 20 young unmarried women like myself, here. They are all early, but fresh-faced, for a common cause. We call ourselves ‘SRHR defenders’ – defenders of sexual and reproductive health and rights of unmarried women in our country. We’ve been working together from this year on ways and means to ensure a safe and stigma-free access to gynaecological services.

I was introduced to this campaign by Mrinalini, a bright, curly-haired girl, whom I met at a Harry Potter fan-club meeting. Maybe it was just the mood of the evening – but Mrinalini, who worked for Haiyya (the sponsoring NGO) reminded of a young Hermione waving SPEW leaflets at her Hogwarts mates.

To me, the campaign sounded like feminism in action – involving groundwork, campaigning, drafting guidelines, canvassing and petitioning. The #HealthOverStigma campaign was my opportunity to prove to the world that I was a feminist and that I was actually doing something about it.

At the time I joined the #HealthOverStigma campaign, I had been to a gynaecologist only once in the 28 years of my life. That was when I believed myself to be dying of hemorrhagic shock. I had struggled with polycystic ovary syndrome (PCOS) for years, but had never got myself treated. The haemorrhage turned out to be due to dengue, but my ‘first time’ with a gynaecologist proved to be fairly simple and satisfactory.

Unfortunately, the experience is not the same for many unmarried women. When we spoke to over a 100 women, startling stories of ostracisation by families, hiding of medical records and horrifying experiences with gynaecologists came to light.

“I went to a doctor to get an infection treated. But once she knew that I was not married and sexually active, she found it immoral to treat me. She asked me to find another doctor,” shared one woman. You can read more such stories here.

Our goal was clear. As fellow defender Swati Gupta puts it, “If you’re an unmarried woman who wants to access sexual healthcare, then you can’t do so because our society decides and disqualifies that need for you. As a defender, I want to change that and make access to sexual healthcare smooth and stigma free.”

So, this is how I ended up spending my Sunday mornings and several evenings (of the week) with this bunch of enterprising women. Training for the defenders entailed educating ourselves in female biology (hence the diagram of the vulva), and getting ourselves examined by a gynaecologist. Our job included creating and conducting surveys, planning, strategising, canvassing on the streets and asking odd questions like, “When was the last time you visited a gynaecologist?”

At times, we felt like lechers. “Do you think she is married?” – we’d whisper to each other, while stalking women at locations ranging from flashy upscale markets like the Greater Kailash market to the hallowed corridors of DU. We tried to reach out to young, unmarried women who faced the greatest risk. Why unmarried women only? In fact, we had intense and even heated debates on who we should include in our demographic (or not), whether our campaign is inclusive enough and who the stakeholders are.

Fellow defender Esha Bansal, 19, says – “It’s baffling to see how ignorant even educated women are of their own bodies, because nobody felt the need to discuss these things in the open. I enjoyed the informative session with the gynaecologists the most, because I got to know so much I wasn’t even aware of, before.”

At the campaign, we made sure that we were learning at every step of the journey. At the end of every meet and during the late-night conference call, we’d ask each other this question – “How are you feeling?”

Frankly, I feel embarrassed. I am 28 years old and the only time I’d been to a gynaecologist was when I thought I was dying. Every time a friend of mine or I have questions related to sex or reproductive organs, we consult each other or the internet – rather than a professional, for fear of shame.

I am embarrassed. I am angry. I am angry at my recently-engaged friend who is asking me what contraceptives she should use. I’m angry that at home, I only dare to call this a ‘health campaign’, and not a ‘sexual and reproductive health campaign’.

I am 28 years old. Many of you reading this are far younger. Do you want to be 28 and still be shy and embarrassed? Confused and misinformed? Our SRHR campaign has created a brilliant opportunity for us to take back our own agency and to take control of our choices to ask for help – to demand help and to demand safe, non-judgemental and easy access to sexual health services.

You can join the fight for our rights. We are petitioning The Federation of Obstetric & Gynaecological Societies of India to make our ’10 commandments’ mandatory in all hospitals across the New Capital Region (NCR). Sign our petition here and get your friends to do the same. Any person of any age, gender or marital status can sign. Help us reach 500 signatures!

Very Young Adolescents’ Sexual and Reproductive Health Needs Must Be Addressed

2017-05-29

More Research Focusing on 10–14-Year-Olds in Developing Countries is Needed

As of 2016, an estimated 545 million very young adolescents aged 10–14 live in developing regions. Early adolescence is a time of physical, social, emotional and cognitive changes, including the onset of puberty and, for some, the initiation of sexual activities. It is therefore a critical time to lay the foundation for healthy and fulfilling sexual and reproductive lives.

A new report published by the Guttmacher Institute examines and contributes to the existing evidence on the sexual and reproductive health (SRH) needs of very young adolescents in developing countries. The report includes a new analysis of data on sexual debut, marriage and childbearing before age 15 from national surveys conducted in more than 100 developing countries. Drawing on these data and published literature, the report maps out ways to advance efforts to meet young adolescents’ SRH needs.

Most very young adolescents in developing countries report that they have never had sexual intercourse, though some have begun to engage in other intimate activities, such as kissing, hugging and fondling. Some adolescents in this age-group do have sexual intercourse. In 2016, very young adolescent girls in developing regions had an estimated 777,000 births. While this makes clear that very young adolescents need to be able to access SRH services, including contraception, there is no available evidence on the extent to which such access exists. However, the evidence on the structural, cultural and legal barriers to access faced by older adolescents in developing countries suggests that younger adolescents likely have a very difficult time obtaining SRH care.

“In addition to access to health services, very young adolescents need information about basic sexual and reproductive health issues so they can protect themselves and make informed, healthy decisions,” says Vanessa Woog, a researcher at the Guttmacher Institute and the report’s lead author. “Creating environments in schools and communities that are supportive of young adolescents’ education on sexual and reproductive health topics is critical.”

Primary school may be a particularly valuable setting for providing comprehensive sexuality education (CSE) to very young adolescents: In most developing countries, more than 80% of 10–14-year-olds are in school. Although many developing countries have national policies and curricula in place that support teaching CSE in schools, there is limited evidence on how or whether such curricula are used and what information actually reaches students.

Certain power imbalances and inequitable gender norms put the SRH of very young adolescents at risk. The report found that for many very young adolescents in developing countries, first sexual intercourse happens as a result of coercion or violence instead of choice. In addition, child marriage continues to occur across many cultures and religions worldwide and affects a significant proportion of very young adolescent girls. The United Nations Population Fund estimates that between 2011 and 2020, 50 million girls in developing countries are at risk of being married by age 15.

“Preventing sexual violence is critical to protecting very young adolescents’ sexual and reproductive health and their long-term well-being,” says Anna Kågesten, independent consultant and coauthor of the report. “The prevalence of sexual violence in young adolescents’ lives points to the urgent need to scale up programs that address the root causes of gender-based violence, including those that promote equitable gender norms.”

The researchers urge program planners and policymakers in developing regions to prioritize evidence-based interventions that have been shown to meet the SRH needs of very young adolescents. Suggested areas of focus include increasing the availability of youth-friendly SRH services among adolescents, keeping very young adolescents—particularly girls—in school, implementing national CSE policies and curricula, and addressing the structural and social causes of gender-based violence and child marriage. The authors also highlight the pressing need for more data specifically on 10–14-year-olds’ sexual and reproductive health. More data are also needed on the experiences and needs of young adolescent males, and those of the most vulnerable groups of very young adolescents—to inform programs and policies aiming to effectively meet the SRH needs of every very young adolescent.

This report has been made possible by UK Aid from the UK Government and a grant from The Children’s Investment Fund Foundation. The views expressed are those of the authors and do not necessarily reflect the positions and policies of the UK Government or The Children’s Investment Fund Foundation.

The Sexual and Reproductive Health Needs of Very Young Adolescents Aged 10–14 in Developing Countries: What Does the Evidence Show?

KEY POINTS

This report draws on analyses of national survey data and literature review results to provide an overview of the evidence on key aspects of sexual and reproductive health among very young adolescents aged 10–14 living in developing regions.

Early adolescence is a period of rapid physical, social, emotional and cognitive changes. As such, it is a critical time to lay the foundation for positive sexual and reproductive health outcomes.

Many developing countries have national policies and curricula that support comprehensive sex education (CSE) in primary schools; however, available data tell us little about the extent to which 10–14-year-olds are actually receiving CSE, or about the quality of such education.

While most very young adolescents report that they have never experienced sexual intercourse, some have begun to explore intimate relationships and to engage in noncoital sexual activities, such as kissing, hugging, fondling, and oral and anal sex.

For many, first sexual intercourse happens as a result of coercion or violence. Between 3% and 23% of adolescent females aged 13–17 report experience of sexual violence in the past year; it is 0–13% among adolescent males.

The proportion of adolescent females married before age 15 varies by country—from less than 1% to 24%—as well as by region, residence and wealth.

Very young adolescent females had an estimated 777,000 births in 2016; 58% of these births took place in Africa, 28% in Asia and 14% in Latin America and the Caribbean. Slightly more than one-third of births to mothers younger than 15 in developing countries were unplanned.

Delivering CSE, continuing to reduce levels of child marriage and sexual violence, emphasizing equitable gender norms, and providing financial incentives in education are some examples of strategies to support sexual and reproductive health among this age-group.

SEXUAL HEALTH: Of men who marry older women

2017-05-23

There is a revolution happening in the world – old people are getting married to young people. Did you know that the first lady of US, Melania Trump, is 24 years younger than President Donald Trump? Incidentally, it has never surfaced as a big deal.

But then there is hullabaloo about the newly elected France president. Emmanuel Macron, 39, is 24 years younger than Brigitte, his wife of close to 23 years. Now this has raised all the media buzz!

“The woman is evil! She is a witch, look at what she has done to someone the age of his son,” said one commentator.

In fact, Macron’s parents transferred him from his high school to another at the age of 15 when they realised that he was relating ‘inappropriately’ with Brigitte, who was then his teacher. Brigitte was at that time 39 and married with three children. It is not clear whether sex happened between the two at the time. They would later reunite and marry when Macron reached the age of majority.

Irrespective of your views on whether President Trump or Brigitte are moral, ethical, right or wrong, that for me is not the issue. The issue is that I have seen a few men in the Sexology clinic with erectile dysfunction after they hooked up with older ladies. Within a few months, they came to the clinic looking for medicine to firm up their dwindling erections.

A full medical history and physical examination showed no indication of any disease. Laboratory tests were also normal.

The main cause of problems in these men was the silent power struggles in the relationship. The African boy child grows up with a picture of superiority in his head. They are made to understand that they are the heads of their houses. The final decisions on how the family should run lies with them.

HARD TO PLEASE

This understanding is reinforced by common place market jokes of how women are inadequate, hard to please, interested in money and looking for an intelligent, shrewd and wealthy macho man to depend on. For communities that circumcise men, those beliefs are drummed into their minds to the extent that they look at their mothers as lesser human beings.

And so the African man is a conqueror of his family. They portray an ego bigger than life to their wives. The wife must learn to be meek and submissive for the marriage to thrive. In fact, many women avoid situations and discussions that can hurt the egos of their husbands.

It is this scenario that makes it fine for an older man to marry a younger woman. Age gives advantage to the man to take his role of leadership and control at the family level easily. Seeing a woman so desperately dependent boosts the man’s ego.

Marrying an older wife challenges this social order. It challenges the power and authority that the man has in the marriage. The moment this power is challenged, the couple always gets into conflict. Further, a man’s ego is closely connected to his sexual performance. The moment his ego is challenged, most men start losing erections.

There are no tablets for treating ED resulting from family power struggles be it age related or otherwise. The treatment is to support the couple to see the source of the problem and work on it to reverse the ED. This means that the woman accepts to let the man be in power or the man finds other ways to express his ego and control.

Some men resolve this by working to earn more money or getting into more positions of greater power compared to the older wife. This way, then the dynamic of powers brought about by age difference is resolved, the man’s ego is regained and he gets back his erection. Please note I am not insinuating that the France president has made it to his position to correct issues relating to bedroom problems.

What is important here is that socialisation has made us what we are and it will take years to correct the notion that old men marrying young girls is fine but not the other way round. An older woman who marries a young man must be prepared for social turbulence and even rejection in some quarters. Such a woman must ensure that there is a balance in power relations in the family.

The man who marries an older wife must, on the other hand, shift his mindset. You cannot have your cake and eat it. You have to be strong enough to dissociate your ego and erection from the near equal or wife superior family power dynamics.

Trump’s gag rule hurts urban poor women

Tne urban poor woman is considered better off than her rural counterpart due to her proximity to health services. The reality is that she is still significantly excluded and marginalised.

Experts now say that the “urban advantage” does not exist for the urban poor woman, especially in accessing sexual and reproductive health services.

“Most of us deliver our babies assisted by traditional birth attendants and most of us still trust our friends for advice and we rarely go to the clinics to seek advice,” says Anastasia Wairimu who works at Mirera Flower Farms in Naivasha.

The recent reinstatement of the global gag rule by the Donald Trump administration will have far-reaching implications on the urban poor who still carry the heaviest load when it comes to maternal mortality.

“The rule means any organisation involved in providing sexual and reproductive health services that uses its own money to provide, or even discuss, abortion services will lose any US development funding it receives,” says Evelyn Samba, the Kenya Country Director, Deutsche Stiftung Weltbevoelkerung (DSW).

“That is, even if the activities for which it receives US funding have nothing to do with pregnancy, family planning or abortions,” she adds. The United Nations Population Fund (UNFPA), which provides family planning services in many developing countries including Kenya, is among the first casualties.

The United States has withdrawn its funding to UNFPA. “Access to sexual and reproductive health services, including family planning, helps in cutting maternal and child deaths, eases the burden of post-abortion care as well as new HIV and STI infections,” Samba expounds.

Wairimu knows all too well the dangers of not using family planning. “The woman who helped me deliver my second born told me that I could not get pregnant since I had just given birth, I stopped using family planning,” she says.

Seven months later while going about her duties at the flower farm, she fainted, only to be taken to the clinic and discover that she was three months pregnant. “It was a difficult pregnancy.

I ended up having a miscarriage and I have been anaemic ever since,” says the 28-year-old Wairimu. Her story is not unique. In fact hers would be considered to have had a happy ending bearing in mind that though at the national level government statistics show that about 362 women die in every 100,000 live births. Among the urban poor, the numbers are higher at over 700 deaths in every 100,000 live births.

“The urban poor woman will most likely deliver at home and be assisted by a traditional birth attendant. When complications arise, there is no way to get this woman to the hospital fast enough, especially because of lack of infrastructure in the slums,” says Dr Gikama Kinyanjui, a gynaecologist and obstetrician in Naivasha.

He says though these women will have attended at least one antenatal clinic visit, nearly half of them will not make it to the recommended four visits.

“This is why the government must focus on raising domestic funding to ensure family planning methods are available for the urban poor woman to avoid unplanned pregnancies,” Dr Gikama expounds.

Samba explains that in the light of dwindling external resources, “county governments need to increase investment in sexual and reproductive health service provision, especially family planning services.”

It is against this backdrop that the County government of Nakuru recently launched guidelines to particularly bring maternal health services closer to its people.

This has been done through the launch of the County Family Planning Costed Implementation Plan 2017-2021. Both national and county governments have expressed commitments to address the main challenges that affect the quality of sexual and reproductive health services that the urban poor woman receives.

This is being done by assessing the demand side and making efforts to remove obstacles that hinder these women from going to health facilities for services in the first place.

There are also initiatives that are working to improve the supply side. “This is where we improve the infrastructure around the health system,” says Dr Kinyanjui.

Other efforts include elimination of the urban exclusion whereby the urban poor have remained marginalised and vulnerable unable to access quality services.

“Continued access to sexual and reproductive health services will likely translate into a healthier, more economically productive population to power Kenya’s development aspirations,” Samba says.

Domestic mobilisation of resources will further ensure successes witnessed particularly in maternal health over the last decade do not go down the drain.

Maternal deaths have dropped from 488 in every 100,000 live births in 2008/09 to the current 362. Deliveries attended by skilled attendant have risen from 43 per cent in 2008/09 to 62 per cent. Within the same period pregnant women who received any antenatal care rose from 92 per cent to 96 per cent.

Bodies in Balance: Does Exercise Affect Sex?

So, the really big question: Does exercise affect sex?

It depends on who you ask. Recently, a study came out that warned guys of the risk to their sex drive if they do too much physical activity. The study found that men who exercise strenuously may have a lower libido than those whose workouts are lighter.

The key words here are may and strenuous. Complications arose when men were exposed to higher levels of chronic intense and greater durations of endurance training on a regular basis. But the majority of people do not consistently exercise at this level, right? So it’s important to read the study and understand if what they analyzed describes you.

Because for most fitness enthusiasts, continuing to exercise on a regular basis does help with intimate relationships and contribute to a healthy sex life. “Exercise is extremely beneficial to sexual desire, performance, and satisfaction, says Lawrence Siegel, MA, CSE, AASECT, a Clinical Sexologist.

“Since sexual function involves more physiological, psychological, and emotional processes than most other human experiences, the closer to optimum levels we are in each state, the greater our sexual experiences,” he says. And since exercise is one of the few things that can help in ALL areas, it is an essential element to achieving those optimum levels of performance and satisfaction (or at least helping one get a bit closer).

What does exercise have to do with sex?

Siegel says exercise, in general, can significantly help achieve better sleep and reduced stress, both of which are important to emotional well being. And if you happen to be one of the millions of people taking an anti-depressant medication, “engaging in exercise is often recommended as a way of overcoming or reducing the negative sexual side effects of these medications, especially in women,” he explains. In fact, research from the University of Texas at Austin found that exercise increases genital arousal in healthy women, likely due to increasing sympathetic nervous system (SNS) activity.

In addition to engaging in daily exercise such as strength training and cardiovascular activities, Siegel also recommends yoga. “Yoga has been shown to provide significant improvement in sexual arousal in women with metabolic syndrome (often a precursor diagnosis to cardiovascular disease and diabetes; related to obesity, lack of activity, and pre-diabetes) and post-menopausal women,” he explains. And for men, “yoga has also been shown to help with erectile dysfunction and rapid (premature) ejaculation, especially when it involves strengthening and opening one’s core and pelvic region,” Siegel adds.

And don’t think you’re going to get through an article on sex without talking about Kegels. Yup, that’s right—those dreaded exercises women are told to practice while waiting at a stop light, sitting in their chair at work, or basically anywhere they can, actually do help with sexual performance—and they are not just beneficial to women. Siegel says by strengthening the pelvic floor muscles, particularly the pubococcygeus or PC muscle, both men and women have reported increases in frequency and intensity of orgasms and the feeling that they have more control. “Women have long reported increased vaginal sensation and sensitivity but there is preliminary evidence to show that Kegel exercises may be very helpful in treating erectile dysfunction, or ED and rapid ejaculation in men,” he adds.

And just in case you need one more reason to be active, both sexually and via exercise, Siegel says that in addition to centuries of anecdotal evidence, there is growing empirical data to support the connection between exercise and well being. “Numerous studies have established strong correlations between moderate exercise and help in relieving depression and anxiety, in addition to improvements in sexual arousal and enjoyment.”

What about nutrition?

We can’t talk about a body being in balance without mentioning food. And according to Siegel, there are a number of nutritional changes people can make to improve sexual desire and arousal. He believes that overall, it’s less about finding specific foods that will increase libido, usually referred to as “aphrodisiacs,” than it is to develop good nutritional strategies.

Siegel says a pro-sexual diet should be based on eating lots of legumes, whole-grain products and other complex carbohydrates, as well as a good amount of nuts, fruits and vegetables. “In particular, cruciferous vegetables like brussels sprouts, cauliflower and broccoli, as well as green leafy vegetables are best, but carrots, beets, garlic, ginger, and avocado are also list toppers, he explains.

These vegetables contain phytonutrients and other substances, such as antioxidants, polyphenols and vitamins, that reduce inflammation and improve metabolic function. “For men, these nutrients have been shown to help prevent BPH, or enlarged prostate, a condition often related to erectile dysfunction and ejaculatory problems,” says Siegel. Other nutrients like vitamin E, nitrates, lycopene, folate, and riboflavin are all helpful at improving sexual health.

“With regard to fruits, it’s hard to go wrong,” says Seigel. Of particular interest are watermelon, papaya, and citrus (go vitamin C!). Lemon should also be on your list because of its ability to decrease acidity in the body. To keep it simple, Siegel says “for the most part, if it’s good for your heart, it’s good for sex!”

Sara Lindberg is a freelance writer specializing in health, fitness and wellness.

Sex Education Programmes in Kenyan Schools Are Failing Students

2017-05-09

Imagine giving Kenyan students something that has been proven to help them make healthy informed choices about their sexual and reproductive lives.

The solution already exists: comprehensive sexuality education.

To be comprehensive, sexuality education needs to be scientifically accurate, age-appropriate, nonjudgmental and gender-sensitive. The lessons should extend to prevention of HIV and other sexually transmitted infections (STIs), as well as contraception and unintended pregnancy. The students should also learn about values and interpersonal skills, gender, and sexual and reproductive rights. Programmes that cover all of these topics can have a positive impact on adolescents’ sexual and reproductive health.

Previous research shows that nationally more than a third of Kenyan teens between the ages of 15 and 19 have already had sex. About one-fifth are currently sexually active. And while only four in ten sexually active unmarried teenage girls use any modern method of contraception, the vast majority of them want to avoid pregnancy. About one-fifth of them are already mothers, and more than half of these births were unplanned.

Early childbearing may limit girls’ ability to stay enrolled in school and to develop the skills needed to successfully transition to adulthood. Knowledge about HIV infection also remains a concern: around half of adolescents in Kenya do not have comprehensive knowledge of HIV/AIDS.

At a time when a new national school curriculum is starting its pilot phase, our recently released study provides critical evidence of the gaps in the content and delivery of existing sexuality education programmes and an opportunity for strengthening them.

The study, conducted in 2015 in 78 public and private schools, found that three out of four surveyed teachers are reportedly teaching all the topics that constitute a comprehensive sexuality education programme. Yet only 2% of the 2,484 sampled students said they learned about all the topics.

Worse still, incomplete and sometimes inaccurate information is being taught. A majority of surveyed teachers reported emphasising in their classes that abstinence is the best or only method to prevent pregnancy and STIs. Yet numerousstudies have shown that abstinence-only programmes do not work.

Only 20% of students in our study had learned about types of contraceptive methods. And even fewer had learned how to use and where to access methods. The majority of teachers also reported very strongly emphasising that having sex is dangerous or immoral for young people. Furthermore, almost six in 10 teachers who teach about condoms incorrectly tell their students that condoms alone are not effective for pregnancy prevention. Something is wrong with this picture

The reality is that at the time of being surveyed for our study, a quarter of the students – who were mostly aged between 15 and 17 – had already had sex. Students want and need information about how to prevent unintended pregnancies, HIV and other STIs.

Slow implementation

Kenya already has the policy infrastructure for a comprehensive programme. Its National School Health Policy was developed by the Ministry of Education and the Ministry of Public Health and Sanitation and their partners in 2009. The policy underscores the need to ensure that students receive quality health education, including sexuality education.

Kenya has also been a signatory since 2013 of a joint health and education ministerial commitment to provide comprehensive and rights-based sex education starting in primary school. Twenty-one other countries of East and Southern Africa are also part of this initiative.

However, implementation has been slow and uneven. Nairobi City county has acknowledged this gap and is working to increase coverage of sexuality education. Recently the county launched a plan of action to strengthen school health programming to increase the number of schools that offer comprehensive sexuality education.

Sexuality education is primarily taught under the subject Life Skills, which is compulsory but not examinable. Teachers face pressure to focus on examinable subjects, such as Mathematics and English. Even in schools that teach a wider range of sexuality education topics, many teachers lack the training to teach them effectively.

We owe it to young people

That’s why the ministries of Health and Education should honour their prior commitments. An immediate priority should be fostering partnerships between schools and community health care providers. Health care providers may be better placed to provide some particularly sensitive sexuality education content, such as where to access and how to use contraceptive methods.

As a longer term priority, the ministries should invest in improved pre-service and in-service teacher training in how to teach sexuality education effectively. They should also ensure that teachers have sufficient time to cover the full range of topics in their classes.

Increased focus on pregnancy and STI prevention strategies should cover a broad range of contraceptive methods and negotiation skills within relationships. This is necessary to ensure that all Kenyan youth have the knowledge to make informed decisions about their sexual and reproductive health. We owe it to young people to do much better.

Disclosure statement

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond the academic appointment above.

Sending the wrong message on sex and reproductive health

By FIONA MACGREGOR | FRONTIER

DON’T DO that! No, I mean it. Really. A video called “Don’t do that”, which has been circulating recently on Myanmar social media attempts to shame and frighten young women with misinformation about unplanned pregnancies and abortions, is extremely damaging.

The short film, sponsored by a popular domestic soft drinks company and produced by Myanmar Media 7 news, follows the story of a young woman. It shows her dancing at a nightclub and then having dates with various men before she becomes pregnant.

If it is meant to be educational, it fails miserably.

The cause of her unplanned pregnancy is merely hinted at. Did it happen when she was seductively sipping juice in the swimming pool? Was it the moment she travelled through Yangon at night with her head protruding from a car’s sunroof? Or was it – as is strongly implied – simply the consequence of being a young woman failing to follow restrictive societal conventions.

But if the “slut-shaming” message of the video is abhorrent in itself (the men in it are not subject to the same judgements), its depiction of the abortion becomes a horror show. Confusing the differences between a medical termination (by taking a pill) and one involving surgery, it ends with the young woman in agony – physical and mental – after being forced to look at the aborted foetus.

Tragically, the reality for women in countries such as Myanmar where abortion is illegal is that those who terminate a pregnancy too often suffer unnecessary, and sometimes fatal, physical and mental trauma that could have been avoided had proper medical services been available to them.

If the moral debate around abortion remains divisive in many parts of the world, the right of women to receive accurate, impartial information and access to family planning and reproductive health services is something that should always be protected.

Yet, early this month the United States government announced that it was halting funding for the United Nations Population Fund (UNFPA), which has been instrumental in providing family planning and maternal health services to women throughout the world and preventing maternal mortality. In other words, UNFPA’s work directly focuses on saving the lives of women and babies.

The cut came after President Donald Trump earlier this year reinstated a ban on US funding for any international organisation that provided any kind of abortion service or advice.

The US is not the only country failing to support women’s reproductive health services at previous levels. Last year Denmark also announced a significant reduction in funding to UNFPA. As donors throughout the world increasingly focus attention on the global refugee crisis, it is feared vital women’s services will lose out – an irony being that displaced women are in particular need of such support.

Myanmar’s 2014 census found that 282 women die for every 100,000 births, or about eight deaths every day. That is double the regional average and more than ten times the mortality ratio of 20 deaths for every 100,000 births in neighbouring Thailand. The need for better family planning and reproductive health services is more than evident.

If anything positive emerged from the “Don’t do that” video, it was the number of Facebook responses from women who objected to its sexism and erroneous information.

“Instead of this story, why don’t you do a story about birth control choices for women and men. Also educate about STDs [sexually transmitted diseases]. This is not convincing me about staying against abortion at all,” wrote one woman.

Another responded, “So much misinformation here! Not all club-going, rich, social girls end up getting knocked-up. (In fact, it’s the poor, uneducated girls who mostly suffer from unwanted pregnancies.) ALSO, taking abortion pills is different from yanking a foetus out. ALSO, since it’s supposed to be ‘educational’, do inform the public about many options such as use of contraceptives, taking morning-after pills, etc, to prevent unwanted pregnancy.”

It is extremely encouraging to see young women standing up for themselves and others and, even though the issue is controversial and potentially emotive, defending their right to receive accurate information free from gender-based discrimination and prejudice.

Yet even among these strong and enlightened young women there were clear gaps in their knowledge of reproductive health options.

One respondent, who made it clear she was aware of emergency contraception and how it works, nevertheless “doubt[ed] you can also abort a baby simply with a pill”.

Another highlighted the discrimination and challenges young women face when it comes to discussing sexuality, and said she believed the reputation of the actress in the video had been ruined by playing the role.

“I am a virgin but I know everyone is using a condom for one night stands. Also, the way you presented [the video] completely destroyed the girl’s career,” she wrote.

The tendency to oppress women’s self expression and freedoms rather than deal with deeper societal problems, permeates much of society in Myanmar.

It was evident when Yangon Region Chief Minister U Phyo Min Thein announced a crackdown on alcohol consumption near Thingyan pandals this year.

“We are ending the situation whereby parents are horrified to see their daughters on the pandals,” he said.

His comments may well reflect traditional cultural values that prioritise the sensibilities of parents over those of their children, but they also exhibit an inherent sexism.

By ignoring the common reports of groping and sexual assaults by male revelers during the festival, and focusing instead on the behaviour of young women whose only “offence” is to be seen enjoying themselves in public, it promotes the idea that “saving face” is more important than defending women’s rights.

This is the kind of attitude that leads to women keeping domestic abuse secret, to sexual assaults going unreported, and to the practice in some communities of women who have been raped being forced to marry their rapist to “protect their family’s honour”.

In previous years, Yangon authorities have demanded that shops clear their shelves of condoms during Thingyan in an ill-advised attempt to control “morality” by depriving people of contraceptives.

The responses to the “Don’t do that” video show that young women want access to the information and services that will allow them to protect themselves and make their own decisions about contraception and how they live their lives.

Politics, religion and policing in this country, as in much of the world, are overwhelmingly dominated by older men, most of whom appear to show little inclination to take the concerns and demands of young women seriously.

All the more important then that funding continues for organisations, international and national, that can provide women with accurate and impartial family planning information and reproductive health services.

Those who support women’s rights everywhere must work to ensure the needs and demands of young women are met and to end the situation in which decisions about women’s health are made by roomfuls of men, whether in Washington or Nay Pyi Taw.